Her aim: To help women without inducing shame, guilt or stigma

01.12.22

[DANISH VERSION]

Karoline Kragelund Nielsen is working to improve the whole care pathway for women with gestational diabetes.

Throughout her career, ever since first taking part in a research project as a 23-year-old student, Karoline Kragelund Nielsen, 38, has been preoccupied with improving women’s health. For the past 10 years, this preoccupation has revolved around non-communicable diseases, especially diabetes, and her research has been driven by her strong desire to involve the target group, alleviate health inequalities and reduce the adverse impact of social determinants.

She is currently putting that approach into practice in her job as Senior Researcher and Team Leader at the Steno Diabetes Center in Copenhagen, and it is that approach and the results achieved through it that have brought her the very prestigious DDA-Funded Scientist Award 2022 – a distinction bestowed on a young scientist who has shown the potential to become a world-class researcher in his or her field.

With a background in public health and epidemiology, her research has focused on the development and evaluation of behavioural change interventions and on the links between biomedical and psychosocial aspects as well as health system research. She herself says that her focus on social inequality and the adverse impact of social determinants and psychosocial factors has been the thread running through her working life, and that one of the things she wants to move forward on is the search for ways of communicating about the risks associated with cardiometabolic conditions in pregnancy without at the same time inducing guilt and shame in women. For example, in her research among women with gestational diabetes in southern India, she saw how a diagnosis of gestational diabetes could be associated with stigmatization, while women’s ability to follow the treatment was restricted by a number of factors in the family, the healthcare system and society as a whole.

‘We know, for example, that the mother’s blood sugar level has a long-term effect on the child, and we know that the woman has an increased risk of subsequent diabetes and cardiovascular disease. But what we need to understand, address and take account of is that this is also affected by factors beyond the individual woman’s control. My concern is therefore not only how we can communicate about those risks without inducing shame and guilt, but also how to address relational, healthcare-systemic and structural barriers’, says Karoline Kragelund Nielsen.

Accordingly, one of the many projects she is currently involved in, called ‘Face-It’, is designed to add to our knowledge of how best to help Danish families where the mother has had gestational diabetes. It is not focused solely on the woman, but includes her partner, too, and also involves a broad collaboration between many disciplines and between Rigshospitalet, Aarhus University, Aarhus University Hospital, Odense University Hospital and the Steno Diabetes Centers in Odense, Aarhus and Copenhagen. Under the project, the researchers have developed a health promotion intervention in the first year following birth, which they are now in the process of evaluating.

The objective is:

To reduce the risk of later type 2 diabetes;
To improve wellbeing and quality of life.

The researchers began by identifying the extant evidence and carrying out qualitative studies involving Danish women with gestational diabetes, their partners and health professionals. The intervention itself was then developed in collaboration with the families and relevant health professionals. The project recruited 330 families during the pregnancy, and they have been invited to attend for a health check approximately 3 months after the birth. A selection of the families will then be invited to take part in the intervention, which will run for the following 9 months or so. When the children are approximately 1 year old, all the families will come in for another health check to find out whether participation in Face-It makes a difference to their physical health, quality of life and mental wellbeing.

The latest children added to the project will celebrate their first birthdays just before the summer holidays, so the researchers expect to have some results in just under a year’s time.

Significant global variation
Another overarching goal of Karoline Kragelund’s research in recent years has been to establish whether there are ethnic differences in the risk of gestational diabetes and in the potential consequences of the condition for mother and child. She and her colleagues have, for example, found significant differences in the risk of gestational diabetes according to the country of origin of women giving birth in Denmark – a difference, it should be noted, that cannot be explained by differences in BMI, age, socioeconomic status etc. In her PhD project, she investigated how screening/diagnosis and treatment of gestational diabetes can be implemented in India and other low- and middle-income countries.

‘There’s a huge gap in our knowledge regarding the best possible way of diagnosing and treating women with gestational diabetes, and not least how to implement effective preventive measures in these countries, where the vast majority of women with gestational diabetes live’, she says.

‘Her focus on social inequality and the adverse impact of social determinants and psychosocial factors has been the thread running through her working life.’

– from the article

‘What we need to understand, address and take account of is that this is also affected by factors beyond the individual woman’s control. My concern is therefore not only how we can communicate about those risks without inducing shame and guilt, but also how to address relational, healthcare-systemic and structural barriers.’

Karoline Kragelund Nielsen

The DDA’s Managing Director, Tore Christiansen, on Karoline Kragelund:
‘Karoline is making an impression not just in Denmark, but also internationally, with her engaging and involving research. Karoline is a unique researcher who gets out of the laboratory and takes her research out into the society around her. This makes her work relevant to citizens and relatives living with diseases, and we are proud of having been able to support Karoline in her research.’

DDA-Funded Scientist Award
This award is presented to an early-career DDA-funded researcher (current or previous) who has shown great potential to be a world‐class researcher within his/her field of expertise. The award is worth DKK 25,000 Danish kroner.

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